To the Editor: Dr McKenzie and
colleagues1 suggest that hydrocortisone, despite its
effectiveness against chronic fatigue syndrome (CFS), should not be
used as a prolonged treatment for CFS because they found that
"cautious hormonal supplementation" consisting of "low-dose"
hydrocortisone caused a significant degree of adrenal suppression. Such
suppression, however, may simply indicate that the dosage of
hydrocortisone was neither cautiously low nor suitable for CFS
patients. Hydrocortisone in dosages greater than 22 mg/d may harm even
subjects with bilateral adrenalectomies,2 whose adrenal
insufficiency is axiomatically absolute. Therefore, the 25- to 35-mg/d
hydrocortisone dosage administered by McKenzie et al clearly represents
an inappropriately high dosage for CFS patients, whose adrenal
insufficiency is mild, since those authors report that "CFS patients
excreted, on average, about 30% less cortisol in 24-hour urine
collections than healthy, matched controls."1